VENOUS DISEASE

"Life for Legs" in the 21st century

In industrialized countries, more than 30% of women and about 10% of men consult for venous signs and symptoms of the legs.

Feelings of heaviness, tiredness and swelling may be present without visible venous disease. Spider veins and varicose veins represent clinical entities requiring special attention. Important factors such as heredity, excess weight, some professions requiring prolonged periods of standing or sitting may increase the risk of developing a chronic venous disease of the legs.

These conditions can evolve and produce complications such as skin pigmentation, chronic oedema, dermititis, eczema, phlebitis and ultimately leg ulcerations.

Deep venous thrombosis may be a consequence as well but it usually occurs without pre-existing venous disease.

UNDERSTANDING THE VENOUS SYSTEM

The venous system

The veins carry the blood back to the heart and lungs. Its blue color (in the diagram) is due to the low oxygen content.

When standing, more than half of the venous blood is in our legs. The blood coming from the legs to the heart has to overcome gravity. This requires the action of a pump. The pump function is mainly achieved by the foot and ankle movement. During each step the muscles compress the veins located inside the calf muscle thereby allowing the venous blood to rush back to the hea

The venous blood return

In healthy individuals, venous blood flows mainly from the superficial veins (located right under the skin) to the deep veins, through the muscles. Once in the deep veins, the blood moves up to the heart and the lungs to be re-oxygenated.

In order to direct the blood flow from the foot to the upper leg, and to prevent it from falling back, the leg veins have thin valves that work as a lock system. Thus, they play a major role in the blood return. Defective valves are mainly responsible for the development of venous disease.

WHAT IS VENOUS DISEASE?

Defective venous valves

In patients with venous disease, the internal walls of the leg veins are deteriorated and the small valves are defective and incompetent.

When a valve is incompetent, blood flows backward to the foot and from the deep veins to the superficial veins. It is called reflux. When valves are incompetent in the superficial veins only, the deep veins have to carry more blood toward the heart. To compensate, the veins expand and the valves may not close anymore. When this happens, such as in the case of severe varicose veins, the deep vein system may become incompetent also.

When blood is no longer pumped effectively from the lower leg, the peripheral veins will not be emptied even when walking. They remain filled with blood and the pressure in the vein will not reduce. This condition is known as chronic venous insufficiency (CVI) which may result in oedema (swelling), skin change and in some cases ulcerations

Origins of venous disease

The causes of venous disease are not clearly identified yet. However, we know that heredity factors play an important role : if both parents have the disease, there is a 90% chance of developing a venous disorder.

In addition to heredity, there are other factors to consider such as :

age

gender

excessive weight

pregnancy

hormonal treatments

professions requiring prolonged standing or sitting

The most important condition leading to chronic venous insufficiency is thrombosis as valves are destroyed when the vessel is cleared from the clots.

Varicose veins - a common case of venous disorder

Varicose veins are one of the most common examples of venous disease in the legs.

The vein is swollen and twisted. The small anti-reflux valves are defective and venous stasis creates a swelling of the skin.

If not treated, varicose veins can lead to the aggravation of the disease.

VENOUS DISORDERS

- Symptoms of venous hypertension such as heavy legs may be present without a visible venous pathology.

- Varicose veins may be present without symptoms but typically progress and lead to chronic venous insufficiency.

- Chronic venous insufficiency reflects a clinical syndrome of skin changes which may lead to serious consequences such as leg ulceration.

- Acute manifestations of venous disease are serious disorders such as phlebitis, thrombosis, deep venous thrombosis (DVT). These acute disorders usually occur suddenly without pre-existing conditions, but can also be triggered by chronic venous disease.

Here is a general description of the different disorders and their symptoms :

CHRONIC VENOUS DISEASES

SIGNS AND SYMPTOMS

Heavy legs

A feeling of discomfort in your legs may be a sign of an underlying venous disorder. These symptoms include tired and achy legs. You may experience them especially when sitting or standing for prolonged hours. During summer time, those symptoms may increase due to the heat. These symptoms are typically associated with swollen feet and ankles (especially in the evening).

The following tips will help relieving and preventing these symptoms :

As for oedemas (swellings) that occur after several hours spent in transportation (airplane, car, train, bus), some easy tips will help you travel with more comfort.

Night cramps are seldom from venous origin. It is important to know that leg pains are not all of venous origin. It is therefore recommended to see your doctor in order for him/her to do a diagnosis and to propose the right treatment for you

Spider veins

They are small, dilated superficial veins. Also known as teleangiectasias, they may be located in different areas of the leg. When found on thighs, they mostly represent just an esthetic problem. However, when located at the ankle, they may represent a serious venous insufficiency. A visit to your physician can detect a possible venous insufficiency. And finally, for esthetic reasons, spider veins can be removed by various simple procedures. After this treatment, 20 to 30 mmHg SIGVARIS compression stockings have proven their efficacy.

Varicose veins

Varicose veins are the sign of a more serious venous disease.

A varicose vein is a dilated and tortuous superficial vein with defective valves. As a result, the blood in these veins flows backward. This condition is known as blood reflux.

Varicose veins can be painful, or on the contrary totally painless. We can find them on the foot, the calf, the thigh or on the entire leg. If not treated varicose veins can lead to serious complications.

Oedemas

When oedema is present, we speak of chronic venous insufficiency.

The oedema of the foot and the ankle occur when the blood stagnates in the superficial and deep veins in the lower part of the leg. The capillaries can no longer play their role. Water and waste build up in the skin in the lower leg and induce a venous oedema (swelling of the foot and the ankle).

However, not all oedemas are of venous origin. Consult your physician for proper diagnosis.

Wearing SIGVARIS compression stocking will reduce or completely eliminate the oedema. The pressure required will be determined by the physician as it depends on the underlying condition.

Dermatitis

The waste built-up leads to tissue damage, and consequently to inflammatory reactions such as eczema.

This is an example of what specialists call a stasis dermatitis.

20 to 30 mmHg SIGVARIS compression stockings will rapidly improve the itching and heal the condition.

Hypodermitis, dermatosclerosis, hyperpigmentation

These terms refer to an inflammation of the skin and underlying tissue, a thickening of the skin and a light to dark brown discoloration all found on the lower part of the leg.

SIGVARIS compression stockings will lead to healing of the dermatosclerosis but not eliminate the hyperpigmentation. The amount of pressure required will be determined by the physician.

The pigmentation will remain even after removal by surgery or sclerotherapy of the responsible varicose veins.

Leg ulcers

A leg ulcer is a wound. It comes most of the time behind and above the ankle on the internal side of the leg. The ulcer is caused by venous stasis. Because the defective veins can no longer assume a good blood return, the cellular wastes are not well cleared up and trigger a toxic environment which prevents healing.

A vicious cycle between chronic venous hypertension and secondary local phenomena develops. Therefore, ulcers will only heal when the venous hypertension is controlled either by eliminating the responsible varicose vein(s) or by applying very strong compression which is usually required when deep veins are affected.

Only a doctor can prescribe the adapted treatment after all necessary exams are performed to identify the exact origin of the ulcer.

ACUTE VENOUS DISEASES

Phlebitis, deep venous thrombosis and pulmonary embolism are the most serious acute manifestations of venous disease. These acute disorders usually occur suddenly without pre-existing conditions, but can also be triggered by chronic venous disease.

Superficial thrombophlebitis

The superficial venous thrombophlebitis is a blood clot (thrombus) that grows lengthwise inside a varicose vein of the superficial venous network (just under the skin), and is often associated with a vein inflamation (phlebitis).

A section of the varicose vein suddenly becomes red, warm, painful and hard. The inflammation can spread upward or downward following the varicose vein. The risk of pulmonary embolism is limited but existing. A visit to the doctor is necessary.

There are no specific reasons that will trigger a thrombophlebitis, sometimes it is caused by a small injury of the veins, more likely to happen when varicose veins are present.

Most of the treatment will consist of wearing 20 to 30 mmHg SIGVARIS medical compression stockings, walking, and applying local anti-inflammatory medication. A surgical drainage or elimination of the varicose vein may also be considered.

Deep vein thrombosis

The phlebothrombosis or deep vein thrombosis (DVT) is the formation of a blood clot in a deep vein of the lower limbs. The blood clot inside the vein can hold onto the vein wall, or it can be floating inside the vein.

A phlebothrombosis can be caused by the following elements:- blood flow alteration- alteration of the blood constituents- defect within the vessels inner layer

The blood flow alteration may follow immobilisation (prolonged bed rests, plaster casting, long distance travel on airplanes, cars, trains). The alteration of the blood constituants can be due to hormonal treatments, smoking, cancers. The defect of the vessel walls can occur after all kind of injuries (trauma, inflammatory diseases, cancer).

Elderly people are at higher risk to develop DVT. However, a person without any previous venous condition can develop a deep vein thrombosis.

The most frequent symptoms of DVT are:- acute pain in the calf;- hardening of the calf;- painful swelling of the ankle that can reach up to the knee, even the thigh.

The calf's pain may cause walking to be difficult. A feeling of heat, a slightly blue or red aspect of the skin may also be observed. When those symptoms occur, you must go see a doctor quickly in order to have an echo-doppler of the veins realized (painless).

The treatment of a deep venous thrombosis will consist of taking anticoagulant drugs, and wearing 20 to 30 mmHg SIGVARIS medical compression stockings that will eliminate the symptoms rapidly and durably and allow to stay mobile and pursue every day activities.

Both components of the treatment will last for several weeks or months.

The major risk in a DVT is to develop pulmonary embolism. This risk however, is minimal if treatment has been initiated. Therefore, treatment can be given on a outpatient basis in most cases.

Pulmonary embolism

Pulmonary embolism occurs when the blood clot, or part of it (emboli), detaches itself and migrates to the pulmonary arteries in the lungs. Most patients with a DVT have an unrecognized pulmonary embolism. The search for its presence is not mandatory as treatment of DVT and pulmonary embolism is the same.

Pulmonary embolism is the most serious consequence of DVT because it may be fatal.

Because those symptoms are also common with other medical conditions. It may not be recognized right away. Only specific tests will enable a correct diagnosis such as lung scan (computer tomography in most cases).

In case of such symptoms, emergency medical assistance must be sought at once. Treatment includes anticoagulant medication.

The majority of people recover from pulmonary embolism. Half of the patients with a big DVT will not recover completely. The valves in the deep veins are irreversibly damaged. The incidence and severity of this outcome are greatly reduced when compression stockings are worn.

However, over 60 000 persons die each year in the USA, over 15 000 in France, as a result of those conditions.

Rupture of varicose vein

Spontaneous or accidental rupture of a varicose vein induces profuse bleeding. It is a serious complication of varicose veins if it is not treated right away. If the patient remains in a standing position, he may get a serious hemorrhage.

To stop the bleeding, raise and maintain the leg above heart level and exert with the fingers a constant pressure on the wound. Do not use a tourniquet. The bleeding will stop after a few minutes. Then apply a firm bandage on the bleeding area and go see your doctor to get the appropriate treament of the affected vein

METHODS OF TREATMENT

Can we cure venous disease ?

Defective venous valves cannot be replaced or fixed. Superficial venous refluxes can be repaired by surgical removal or sclerotherapy of the varicose vein(s). However, chronic venous disease due to deep venous incompetence - such as in post-thrombotic syndrome - cannot be cured.

Chronic venous disease evolves with time. Therapy consists of methods that help to reduce the "ambulatory venous hyperpressure".

Phlebologists, - physicians specialized in veno-lymphatic diseases -, all agree that compression stockings are THE basic treatment of venous disease. This is the reason why medical compression stockings are recognized as a medicine.

SIGVARIS medical compression stockings combined with movement will ease the venous blood return, decrease the hyperpressure, and slow down the evolution of the disease.

COMPRESSION THERAPY

Principle and action

The concept of compression therapy lies on a simple and efficient mechanical principle : it consists of applying an elastic garment around the leg.

By compressing the limb with graduated compression - strong at the ankle and decreasing going up the leg, the compression stocking helps the venous return, decreases venous pressure, prevents venous stasis and impairment of venous walls, and efficiently relieves aching and heavy legs

Indications and contra-indications

This treatment is prescribed by a physician to treat phlebitis, thrombosis, vein surgery aftercare, and to relieve all manifestations of chronic venous disease (heavy legs, varicose veins, oedemas, leg ulcers..). It can also be prescribed to prevent venous troubles during pregnancy and long distance travel.

Contraindications are limited : advanced peripheral obstructive arterial disease, congestive heart failure, septic phlebitis, oozing dermatitis, advanced peripheral neuropathy. Very few cases of allergy have been reported to one of the components.

There are no secondary effects with compression therapy treatment when manufacturer's sizing chart is strictly followed.

Compression classes

Compression stockings are available in different degrees of compression depending on the severity of the pathology to be treated. The pressure exerted by a compression stocking at ankle level is measured in millimeters of mercury (mmHg). Compression classes are defined according to different official norms (AFNOR in France, GZG in Germany ).

The physician prescribes the compression class corresponding to the pathology of the patient. Light compression is class 1 or 2, strong compression is class 3 or 4 depending on the norm used.

We at SIGVARIS suggest that pressure exerted at the ankle be given in mmHg.

Treatment dispensation

Depending on the pathology, medical compression therapy can be applied in different forms : socks, stockings, pantyhose or bandages.

The current new textures and fashion designs of SIGVARIS® compression products make compliance with the treatment much better and efficient.